THE IMPACT OF COMBINATION ANTIHYPERTENSION THERAPY ON THE MAIN PARAMETERS OF STRUCTURAL AND FUNCTIONAL CONDITION OF THE LEFT VENTRICLE MYOCARDIUM IN NON-CONTROLLED ARTERIAL HYPERTENSION WITH DEPRESSION SPECTRUM DISORDER

Material and methods. Totally 160 patients included, with NCAH and DD, median age 58 (53-64) y.o., who were administered combination therapy that included angiotensin-converting enzyme inhibitor perindopril 10 mg/day and diuretic indapamide SR 1,5 mg/day. The patients were randomized into 2 groups: to the 1st group we added escitalopram (Selectra, Abbott Laboratories) as antidepressant, 10 mg/ day; to the 2nd group — calcium channel antagonist (CA) amlodipine 5-10 mg/day. All patients at the baseline and in 6 months underwent ambulatory blood pressure monitoring (ABPM), echocardiography, DD diagnostics with the Tsung and HADS scores.

Results. After 4 weeks of treatment the therapy that included antidepressant led to the decrease of BP to target levels in 52,6% of patients, in CA — in 24,4%, and in 24 weeks of treatment there was comparable number of target reached patients in both groups. Comparative analysis of cardioprotection action of combination antihypertension therapy showed that in the usage oif antidepressant, as in CA usage there was comparable regression of hypertrophy and diastolic function of LV myocardium. With the treatment, in the 1st group there was increase of patients with normal geometry of the LV by 54,7%, and in the 2nd group — by 52,4% (p<0,05). In the 1 and 2 groups we saw the increase of those with normalized diastolic LV function: to 68,8% and to 65,1%, respectively (p<0,05).

Conclusion. Addition of escitalopram as part of combination therapy mediated a significant antihypertensive effect, a little overcoming the treatment with amlodipine addition. Usage of tetracomponent therapy in combination of HADS and DD led to significant and comparable regression of structural and functional changes of the LV myocardium, that can be utilized for optimization of arterial hypertension control in this category of patients.

1. Chazova IE, Fomin VV, Razuvaeva MA. Resistance and uncontrolled hypertension: the challenge of the XXI century. Pharmateca 2011; 5: 8-13. Russian (Чазова И. Е., Фомин В. В., Разуваева М. А. Резистентная и неконтролируемая артериальная гипертензия: проблема XXI века. Фарматека 2011; 5: 8-13).

2. Chazova IE, Fomin VV, Razuvaeva MA. Epidemiological characteristics of resistant and uncontrolled hypertension in the Russian Federation. Systemic Hypertension. 2010; 3: 34-41. Russian (Чазова И. Е., Фомин В. В., Разуваева М. А. и др. Эпидемиологическая характеристика резистентной и неконтролируемой артериальной гипертензии в Российской Федерации. Системные гипертензии 2010; 3: 34-41).

3. Scuteri A, Castello L, Coluccia R, et al. Depression is associated with increased occurrence of left ventricle concentric geometry in older subjects independently of blood pressure levels. Nutrition, Metabolism and Cardiovascular Diseases 2011; 21(12): 915-21.

4. Nemeroff CB, Goldschmidt-Clermont PJ. Heartache and heartbreak — the link between depression and cardiovascular disease. Nature Reviews Cardiology 2012; 9(9): 526-39.

5. Vasjuk UA, Dovzhenko TV, Nesterova EA, et al. Left ventricular remodeling in hypertensive patients with anxiety and depressive disorders in the combined therapy antihypertensive drugs and antidepressants. Rational Pharmacotherapy in Cardiology 2008; 3 (4): 76-82. Russian (Васюк Ю. А., Довженко Т. В., Нестерова Е. А. и др. Особенности ремоделирования левого желудочка у больных артериальной гипертонией с тревожно-депрессивными расстройствами на фоне комбинированной терапии гипотензивными препаратами и антидепрессантами. Рациональная фармакотерапия в кардиологии 2008; 3 (4): 76-82).

6. The Federal guidelines for the diagnosis and treatment of recurrent depressive disorder. 2013; http://psychiatr.ru/. Russian (Федеральные клинические рекомендации по диагностике и лечению рекуррентного депрессивного расстройства. 2013; http://psychiatr.ru/).

7. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging. American Society of. Echocardiography 2015; 28 (1): 14-39.

8. Pristrom MS, Sushinskij VE. Diastolic myocardial dysfunction: diagnosis and treatment approaches. Medical News. 2008; 12: 17-9. Russian (Пристром М. С., Сушинский В. Э. Диастолическая дисфункция миокарда: диагностика и подходы к лечению. Медицинские новости. 2008; 12: 17-9).

9. Serretti A, Olgiati P. Biochemistry of depressive disorders. Role of serotonin, amino acid neurotransmitters, substance P and neurosteroids. Clinical Neuropsychiatry 2008; 5(5): 225-41.

10. Kirino E. Escitalopram for the management of major depressive disorder: a review of its efficacy, safety, and patient acceptability. Patient Preference and Adherence. 2012;6:853.

11. Artigas F. Serotonin receptors involved in antidepressant effects. Pharmacology & Therapeutics 2013; 137(1): 119-31.

12. Jaffre F, Bonnin P, Callebert J, et al. Serotonin and angiotensin receptors in cardiac fibroblasts coregulate adrenergic-dependent cardiac hypertrophy. Circulation Research 2009; 104(1): 113-23.

13. Shyu KG. Serotonin 5-HT2B receptor in cardiac fibroblast contributes to cardiac hypertrophy: a new therapeutic target for heart failure. Circulation Research 2009; 104(1): 1-3.

14. Ayme-Dietrich E, Marzak H, Lawson R, et al. Contribution of serotonin to cardiac remodeling associated with hypertensive diastolic ventricular dysfunction in rats. J Hypertens 2015; Aug 7. [Epub ahead of print].

15. Carney RM, Freedland KE, Veith RC. Depression, the autonomic nervous system, and coronary heart disease. Psychosom Med 2005; 67 (1): 29-33.